Provider Demographics
NPI:1255496238
Name:GRABAREK, THOMAS J (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:GRABAREK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S HUMPHREYS ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5623
Mailing Address - Country:US
Mailing Address - Phone:928-214-7169
Mailing Address - Fax:928-214-8973
Practice Address - Street 1:304 S HUMPHREYS ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5623
Practice Address - Country:US
Practice Address - Phone:928-214-7169
Practice Address - Fax:928-214-8973
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAG2415912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAG2415912OtherDEA#